China has been already in the stage of deeply aging society, and the health problems of the elderly are getting more and more attention. Depression in the elderly not only affects the quality of life in later life, but also increases the economic burden on society and families, so early identification of the influencing factors of its development is of great significance. However, the existing research conclusions are still controversial, and there are few relevant systematic reviews in China.

To explore the depression detection rate and its influencing factors in the elderly in China since 2018, provide reference for reducing the incidence of depression in the elderly and promoting healthy aging.

In January 2023, PubMed, EmBase, Web of Science, CNKI, Wanfang Date and VIP were searched for publicly available studies on factors influencing depression in Chinese elderly from 2018 to 2022. The data were extracted and the literature quality was evaluated according to the cross-sectional study quality assessment criteria of Agency for Healthcare Research and Quality (AHRQ) and Stata 15.0 was adopted for Meta-analysis.

Twenty-three papers were finally included, with a cumulative study population of 75 599, and a total of 13 815 depressed older adults were detected; the AHRQ quality assessment scores of the papers ranged from 5 to 7. Meta-analysis results showed that the detection rate of depression in the elderly in China was 20.6%〔95%CI (16.6%, 24.8%) 〕, female〔OR=1.46, 95%CI (1.30, 1.64) 〕, advanced age〔OR=1.48, 95%CI (1.13, 1.94) 〕, lower education level〔OR=1.52, 95%CI (1.32, 1.75) 〕, no spouse〔OR=1.60, 95%CI (1.35, 1.91) 〕, living in rural areas〔OR=1.38, 95%CI (1.14, 1.66) 〕, suffering from chronic diseases〔OR=2.75, 95%CI (2.07, 3.66) 〕, 2 chronic diseases〔OR=1.84, 95%CI (1.07, 3.14) 〕, 3 or more chronic diseases〔OR=3.86, 95%CI (2.89, 5.15) 〕, poor self-rated health〔OR=3.47, 95%CI (1.14, 10.53) 〕, insomnia〔OR=2.62, 95%CI (1.88, 3.66) 〕, living alone〔OR=1.86, 95%CI (1.56, 2.21) 〕, no exercise〔OR=1.88, 95%CI (1.60, 2.20) 〕, self-care needs or partial needs〔OR=2.96, 95%CI (1.12, 7.85) 〕were risk factors for depression in the elderly (P<0.05), while drinking〔OR=0.67, 95%CI (0.50, 0.88) 〕and having friends〔OR=0.52, 95%CI (0.38, 0.71) 〕were protective factors (P<0.05) .

Although the detection rate of depression among elderly in China has decreased, it is still at a high level, and the elderly in China who are female, elderly, less educated, without spouse, living in rural areas, suffering from chronic diseases and chronic disease comorbidity, with poor self-rated health, suffering from insomnia, living alone, without exercise, and living in need or partial need of self-care may be more likely to suffer from depression.

Polypharmacy is increasingly common in the elderly. The medication compliance of polypharmacy is closely related to its therapeutic effect and safety. Therefore, it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage. However, the conclusions of current studies vary greatly, and there is no clear and unified standard.

To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors, in order to provide reference for improving medication compliance of polypharmacy in the elderly, reducing adverse reactions, and further developing individualized intervention programs.

PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid, CBM, CNKI, Wanfang Data and VIP were searched for cohort studies, case-control studies, cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023. Two researchers independently screened the literature, evaluated the quality and extracted the data according to the inclusion and exclusion criteria. Stata 17.0 and RevMan 5.3 software were used for meta-analysis.

A total of 19 studies were included with the total sample size of 130 047 subjects, including 50 852 subjects with good medication compliance. Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI (34%, 47%) 〕, which was associated with age〔OR=2.62, 95%CI (1.60, 4.78), P<0.000 1〕, gender〔OR=1.70, 95%CI (1.30, 2.23), P=0.000 1〕, education level〔OR=1.73, 95%CI (1.38, 2.16), P<0.000 01〕, residential lifestyle〔OR=2.85, 95%CI (2.18, 3.72), P<0.000 01〕, medication knowledge level〔OR=1.14, 95%CI (1.04, 1.25), P=0.005〕, medication belief〔OR=2.06, 95%CI (1.44, 2.93), P<0.000 1〕, depression〔OR=2.52, 95%CI (1.96, 3.24), P<0.000 01〕, daily living ability (ADL) 〔OR=2.39, 95%CI (1.68, 3.38), P<0.000 01〕, history of falls〔OR=3.51, 95%CI (2.03, 6.06), P<0.000 01〕, professional guidance 〔OR=3.75, 95%CI (1.92, 7.33), P=0.000 1〕, the number of drug types〔OR=2.58, 95%CI (1.96, 3.41), P<0.000 1〕, adverse drug reactions〔OR=3.08, 95%CI (2.17, 4.38), P<0.000 1〕, medication regimen complexity〔OR=1.08, 95%CI (1.03, 1.14), P=0.004〕, medication management〔OR=1.92, 95%CI (1.34, 2.75), P=0.000 3〕 and medication cost〔OR=2.60, 95%CI (1.30, 5.17), P=0.000 7〕. Sensitivity analysis showed that the results of meta-analysis were relatively stable. Begg's test (P=0.441) and Egger's test (P=0.674) suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies.

The compliance rate of polypharmacy in the elderly is 41%. And the available evidence shows that general factors (age, gender, education level, residential lifestyle), psychological and social factors (depression, ADL, history of falls, medication knowledge level, medication belief, professional guidance), drug factors (medication management, medication cost, medication regimen complexity, the number of drug types, adverse drug reactions) are the influencing factors of medication compliance of polypharmacy in the elderly. Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.

An increasing number of studies have demonstrated that potentially inappropriate medication (PIM) occurs commonly in elderly patients with cancer, with higher prevalence of PIM than general elderly, which may lead to adverse effects on prognosis of the patients. Therefore, it is necessary to conduct a systematic and comprehensive review of previous studies to provide support and reference for future studies. PubMed, CNKI and Wanfang Data were systematically searched to summarize and analyze the screen tools of PIM, prevalence of PIM, main drugs involved, influencing factors and the relationship between PIM and adverse outcomes. The results showed that the prevalence of PIM varied when different PIM screen tools were used in older patients with cancer, and the list of medications commonly used for supportive care that are of concern in older patients provided by the NCCN Guidelines for Older Adult Oncology (2020.v2) demonstrated advantages in providing individualized medication management for elderly patients with cancer. Polypharmacy, age, and comorbidities were significantly associated with the development of PIM. Benzodiazepines and analgesics are commonly used as high-risk drugs in elderly patients with cancer. PIM may be associated with higher mortality rates, drug interaction rates, adverse event rates, emergency and hospital readmission rates in elderly patients with cancer. It is hoped that this article will provide a reference for conducting studies related to PIM in elderly patients with cancer in China and provide support for promoting the safe and rational use of medication in elderly patients with cancer.

Direct oral anticoagulants (DOACs) have gradually replaced the vitamin K antagonist warfarin and become the first line drugs for anticoagulant therapy in patients with non-valvular atrial fibrillation (NVAF), however, the safety and efficacy of DOACs in clinical use require sustained attention.

To promote rational use of DOACs by investigating and analyzing the potentially inappropriate medication (PIM) of DOACs in elderly patients with atrial fibrillation (AF) hospitalized in Cardiology Department.

Beers criteria, DOACs drug inserts and anticoagulant treatment guidelines were integrated to develop the PIM evaluation criteria for DOACs therapy, including criterias for the indication of DOACs for AF, PIM evaluation of DOACs dose matched to renal function, DOACs application in patients with different liver function and PIM evaluation of DOACs drug interaction, evaluation references for age related PIM, body weight related PIM and bleeding risk related PIM. A retrospective analysis was performed to collect elderly NVAF patients from Hospital Information System (HIS) who were admitted to the department of cardiology and received DOACs (rivaroxaban tablets, edoxaban tablets and dabigatran etexilate capsules) therapy from January 2022 to December 2022 in the Second Affiliated Hospital of Zhejiang Chinese Medical University. The target population was screened according to the inclusion and exclusion criteria and evaluated individually according to the PIM evaluation criteria.

A total of 89 elderly NVAF patients were enrolled with an average age of (77.9±8.1) years, and the incidence of PIM was 56.18% (50/89). A total of 58 cases of PIM in the three DOACs, including 47 cases (81.03%) in the rivaroxaban, 6 cases (10.35%) in the edoxaban and 5 cases (8.62%) in the dabigatran etexilate. Sorted by PIM categories, the incidence of renal function-related PIM was 75.86% (44 cases), drug interaction related PIM was 15.52% (9 cases), liver function related PIM was 6.90% (4 cases) and weight related PIM was 1.72% (1 case) .

Anticoagulation treatment with DOACs in elderly patients with NVAF is associated with non-negligible PIM, rivaroxaban-treated patients have the highest incidence of PIM, followed by edoxaban-treated patients, which mainly manifests as renal function related PIM, drug interaction related PIM and liver function related PIM. Therefore, the clinicians need to develop individualized anticoagulation regimens integrating patient-specific conditions in the anticoagulation in elderly patients with NVAF, thereby reducing the PIM of DOACs therapy.

In recent years, there has been a noticeable increase in the prevalence of polypharmacy among the older population, leading to a rise in the number of related studies. As a result, a stage analysis of its development is crucial.

To analyze the research trends and cutting-edge topics in the field of polypharmacy in the elderly from 2003 to 2022.

The Science Citation Index Expanded (SCI-E) and Social Sciences Citation Index (SSCI) subsets of the Web of Science Core Collection database were searched for articles and reviews about polypharmacy in the elderly published in English between 2003 and 2022. VOSviewer (v.1.6.18) and CiteSpace (v.6.1.R6) were used for bibliometric analysis.

A total of 3 987 articles were obtained, including 3 208 articles and 779 reviews. The global volume of publications has increased rapidly in the last 20 years, with the United States (1 097 articles, 27.51%) having the most publications in this field. The University of Sydney in Australia has been the most prolific institution, publishing 156 articles (3.91%), while Dr. Sarah N. Hilmer of this institution has been the most productive author with 67 publications (1.68%). Among the journals, Drugs & Aging (181 articles, 4.54%) has featured the highest number of publications related to polypharmacy in older people. The high-frequency keywords in the field included elderly, polypharmacy, prevalence, and risk, while the current emerging topics revolved around clinical outcomes and public health issues about polypharmacy in the elderly.

Over the past two decades, the field of polypharmacy among older people has experienced rapid progress, characterized by an increasing number of publications with the United States as the largest contributor. Research topics have primarily focused on the prevalence and risks associated with polypharmacy among older people, while future studies are expected to focus more on the associated clinical outcomes and public health issues.

Hyperuricemia (HUA) caused by elevated serum uric acid (SUA) has been shown to be an independent risk factor for the development and progression of chronic kidney disease (CKD). However, there are few cohort studies on the correlation of SUA level with the development and progression of CKD in the elderly of China.

To explore the association of baseline SUA level and its changes with the risk of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) in the elderly in longevity areas of China.

Based on the Healthy Aging and Biomarkers Cohort Study (HABCS), a sub cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the older adults who received physical examination and with biomedical indicators in 2012 and 2014 were selected as the study subjects from December 2021 to May 2022. The age, gender, blood pressure, blood lipids, blood glucose and other biomedical indicators were collected at baseline and follow-up period. Cox proportional hazards regression model was used to analyze the association of different SUA levels with the risk of CKD. Spearman rank correlation and generalized linear model analysis were used to analyze the association between baseline SUA level and baseline eGFR level and the linear correlation between changes in SUA level and eGFR changes in the elderly, respectively.

A total of 981 subjects were included in the study, with the median age of 79 (70, 88) years, the prevalence of HUA of 6.8% (67/981), the cumulative follow-up of 2 029 person-years and the median follow-up of 2.05 years, including 179 new cases of CKD, the cumulative incidence of CKD during the follow-up was 18.2%〔95%CI (15.9%, 20.8%) 〕, and the incidence density was 88.22/1 000 person-years〔95%CI (76.24/1 000 person-years, 101.41/1 000 person-years) 〕. Cox proportional hazards regression analysis with SUA quartile grouping as the independent variable showed that compared with the lowest quartile group of baseline SUA level (Q1), the HR value for the risk of CKD in the highest quartile group of baseline SUA level (Q4) was 2.08〔95%CI (1.27, 3.41), P=0.004〕. Cox proportional hazards regression analysis with SUA level as the independent variable showed that, for every 10 μmol/L increase in baseline SUA level, the risk of CKD in the elderly increased by 4% (P<0.001). Cox proportional hazards regression analysis with HUA as the independent variable showed an increased risk of CKD in elderly with HUA compared to those without HUA, with the HR value of 2.00〔95%CI (1.20, 3.24), P=0.007〕. The median baseline SUA was 270.60 (223.10, 325.90) μmol/L, the median baseline eGFR was 84.07 (73.08, 98.38) mL·min^-1· (1.73 m²) ^-1 in the elderly. Spearman rank correlation analysis showed a negative correlation between the above two (r_s=-0.363, P<0.001). The results of generalized linear model analysis showed that for every 10 μmol/L increase in baseline SUA level, the baseline eGFR decreased by 0.897 mL·min^-1· (1.73 m²) ^-1 (P<0.001). The median change of SUA level was -3.55 (-40.60, 31.90) μmol/L and the median change of eGFR was 3.49 (-8.13, 15.89) mL·min^-1· (1.73 m²) ^-1 in the elderly during the follow-up period of this study, and Spearman rank correlation analysis showed a negative correlation between the above two (r_s=-0.355, P<0.001). The results of the generalized linear model analysis showed that for every 10 μmol/L increase in SUA level in the elderly during the follow-up period, eGFR decreased by 1.027 mL·min^-1· (1.73 m²) ^-1 in the elderly (P<0.001) .

Elevated SUA level in the elderly is associated with an increased risk of CKD and a declined eGFR in China.

Insufficient physical activity is one of the most important public health problems in the 21st century and studies have found an association between physical activity and mortality. The effect of physical activity on mortality risk has attracted much attention in recent years, but few studies have reported the relationship between physical activity and all-cause mortality risk in different populations.

To explore the relationship between physical activity and all-cause mortality risk in middle-aged and older adults (45 years old and above) in China.

Based on the data of China Health and Retirement Tracking Survey (CHARLS) from 2011 to 2018, a total of 2 799 middle-aged and older adults from the 2011 baseline population of the CHARLS were selected as the research subjects on September 10, 2022, their baseline data such as demographic variables, lifestyle variables, and number of chronic diseases were collected, and physical activity level was evaluated based on the International Physical Activity Questionnaire (IPAQ) as low level physical activity〔600 metabolic equivalent (MET) /week) 〕, moderate level of physical activity (600-3 000 MET/week), high level of physical activity (3 000 MET/week). The follow-up period was from 2011 to 2018, and data from 2013, 2015 and 2018 were selected for follow-up, with all-cause death as the endpoint event, and the subjects were divided into the survival group (n=2 424) and all-cause death group (n=375) according to their survival status. Cox proportional hazard regression model was used to analyze the relationship between physical activity level and all-cause mortality risk in middle-aged and older adults, sensitivity analysis and stratification analysis were also performed.

During the 7-year follow-up, 375 cases of all-cause death occurred among 2 799 middle-aged and older adults with the incidence of all-cause death of 13.40%. There were statistically significant differences in physical activity level, gender, age, marital status, education level, ADL limitation, BMI, smoking, alcohol consumption and the number of chronic diseases between the survival group and all-cause death group (P<0.05). After adjusting for confounding factors, multivariate Cox proportional hazard regression analysis showed that the risk of all-cause death was reduced by 43%〔HR=0.57, 95%CI (0.44, 0.75), P<0.001〕and 64%〔HR=0.36, 95%CI (0.27, 0.48), P<0.001〕in the middle-aged and older adults with low level of physical activity and high level of physical activity, respectively. The results of both sensitivity analyses showed a reduced risk of all-cause mortality in the middle-aged and older adults with moderate and high levels of physical activity compared with those with low level of physical activity (P<0.001), indicating that the results are robust. Stratified analysis showed that moderate level of physical activity could reduce the risk of all-cause death by 50%〔HR=0.50, 95%CI (0.33, 0.76), P<0.001〕in people aged 60-74 years and 51%〔HR=0.49, 95%CI (0.33, 0.73), P<0.001〕in people with normal BMI. High levels of physical activity were associated with a 74%〔HR=0.26, 95%CI (0.14, 0.47), P<0.001〕 and 65%〔HR=0.35, 95%CI (0.24, 0.51), P<0.001〕lower risk of all-cause death in people aged 45 to 59 and 60 to 74 years, respectively, and a 71%〔HR=0.29, 95%CI (0.20, 0.43), P<0.001〕and 64%〔HR=0.36, 95%CI (0.22, 0.59), P<0.001〕lower risk of all-cause death in people with normal BMI, overweight or obesity.

Both moderate and high levels of physical activity can reduce the risk of all-cause death in middle-aged and older adults, and the effect of high level of physical activity is more obvious. From the perspective of reducing the risk of all-cause death, it is suitable for people aged 45-59 years old, overweight and obese people to choose high level of physical activity. People aged 60-74 years and with normal BMI can benefit from moderate or high levels of physical activity. There is no clear recommendation with sufficient evidence for people aged≥75 years old and lean people, who should make decisions according to their own specific situations.

The Beers criteria is a tool for evaluating potentially inappropriate medication (PIM) in elderly patients widely used in various fields, such as clinical practice, teaching research, supervision and administration. The 2023 American Geriatrics Society Beers criteria (AGS Beers criteria) for PIM use in older adults are the seventh overall update, using the development methodology following previous versions, which includes the rigor of the evidence review and synthesis process. This paper provides a detailed interpretation of the new version of AGS Beers criteria. The AGS Beers criteria aims to reduce the incidence of PIM in older adults by optimizing drug selection. The 2023 AGS Beers criteria can also be used in the education of clinicians and patients, assessment of care quality, health care costs and drug use patterns in older adults. In addition to the five tables associated with PIM as main contents, several drugs and criteria have been added based on updated evidence, mainly on the revisions and streamlining of existing drugs and criteria. The added and revised content mainly involves anticoagulants, antiplatelet agents and hypoglycemic agents. The synthesis of anticoagulation recommendations has been added in the new version of AGS Beers criteria. Thirty-three drugs were removed due to low usage or not on the U.S. market. The 2023 AGS Beers criteria summarizes seven principles on the application of Beers criteria to ensure proper clinical use. Overall, the 2023 AGS Beers criteria have improved its accuracy and utility, which can better identify and reduce PIM prescriptions for the elderly patients and further guide the clinical development of rational drug use regimens.

China has entered a comprehensive aging society, and stroke is the primary cause of death and disability among adults in China, post-stroke cognitive impairment has become an important cause for long-term disability and quality of life decline in stroke patients.

To analyse and clarify the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China by Meta-analysis.

CNKI, Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched by computer to collect cohort, case-control, and cross-sectional studies on influencing factors of cognitive impairment in elderly stroke patients from inception to 2023-02-12. After independent screening of the literature and data extraction by two investigators, the quality of the literature was assessed and a Meta-analysis of the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China was performed using Stata 14.0 software.

A total of 46 papers were included, with 3 281 cases of cognitive impairment and 27 influencing factors involved. The Meta-analysis results showed that the prevalence of cognitive impairment in elderly stroke patients in China was 42.4%〔95%CI (36.6%, 48.3%) 〕; female〔OR=4.167, 95%CI (1.937, 8.967), P<0.001〕, hypertension〔OR=2.824, 95%CI (2.292, 3.481), P<0.001〕, systolic blood pressure〔OR=1.572, 95%CI (1.444, 1.711), P<0.001〕, diabetes mellitus〔OR=3.344, 95%CI (2.611, 4.284), P<0.001〕, hyperlipidemia 〔OR=2.228, 95%CI (1.091, 4.547), P=0.028〕, carotid plaque 〔OR=2.544, 95%CI (1.076, 6.014), P=0.033〕, infarction location of frontal lobe〔OR=1.615, 95%CI (1.167, 2.235), P=0.004〕, infarction location of temporal lobe〔OR=1.739, 95%CI (1.246, 2.427), P=0.001〕, multiple cerebral infarction〔OR=2.583, 95%CI (2.009, 3.321), P<0.001〕, encephalanalosis 〔OR=2.943, 95%CI (1.938, 4.469), P<0.001〕, homocysteine (Hcy) 〔OR=2.209, 95%CI (1.656, 2.948), P<0.001〕, hyperhomocysteinemia〔OR=3.043, 95%CI (2.092, 4.426), P<0.001〕, high-sensitivity C-reactive protein (hs-CRP) 〔OR=4.331, 95%CI (1.756, 10.685), P=0.001〕, and National Institutes of Health Stroke Scale (NIHSS) score >10〔OR=1.977, 95%CI (1.320, 2.961), P=0.001〕 were influencing factors for cognitive impairment in elderly stroke patients in China.

The prevalence of cognitive impairment in elderly stroke patients in China was high (42.4%), and female, hypertension, systolic blood pressure, diabetes mellitus, hyperlipidemia, carotid plaque, infarction location of frontal lobe and temporal lobe, multiple cerebral infarction, encephalanalosis, Hcy, hyperhomocysteinemia, hs-CRP, and NIHSS score >10 were influencing factors for cognitive impairment in elderly stroke patients in China.

The prevalence of hypertension in population is still increasing by year, and the significant increase in the prevalence of chronic diseases caused by aging of the population results in a serious medical burden. There are still about 450 million people in China who use solid fuels for cooking or heating, causing indoor air pollution as an important public health problem in China. At present, the relationship between solid fuels use and the risk of hypertension in Chinese older adults still remains unclear.

To analyze the association between solid fuels use and the risk of hypertension in older adults in urban and rural areas of China through a prospective cohort study, so as to provide a theoretical basis for the prevention and treatment of hypertension in the elderly.

This study is a prospective cohort study. Data were obtained from 2011 to 2018 China Longitudinal Healthy Longevity Survey (CLHLS) by using baseline questionnaire and physical examination. A total of 1 453 non-hypertensive older adults aged 65 years and above from 2011 to 2012 cohort were included in the study, and the occurrence of hypertension during follow-up was considered as the outcome indicator, follow-up as of 2018-12-31. The included subjects were divided into the clean fuel (electrical appliances such as induction cooker, pipeline natural gas, solar energy) group (n=654) and solid fuel (charcoal, kerosene, coal, firewood) group (n=799). Multivariate Cox proportional hazard regression model was used to analyze the association between cooking with solid fuels and the risk of hypertension.

A total of 1 453 non-hypertensive older adults at baseline with an average age of (77.6±8.8) years and a median follow-up of 7 years, and a total of 838 people developed hypertension at the outcome. The results of this study showed that the proportion of cooking with solid fuels in rural areas was significantly higher than that in urban areas (70.3% vs. 1.1%, P<0.05). Multivariate Cox proportional hazard regression model showed that cooking with solid fuels significantly increased the risk of hypertension〔HR=1.20, 95%CI (1.05, 1.38), P=0.01〕, and the adjustment for covariates still indicated that it increased the risk of hypertension〔HR=1.21, 95%CI (1.04, 1.41), P=0.01〕. In addition, cooking with solid fuels was positively associated with abnormal mean arterial pressure (MAP) 〔HR=1.26, 95%CI (1.02, 1.55), P=0.03〕; and the adjustment for covariates still showed positive association of it with abnormal MAP〔HR=1.28, 95%CI (1.02, 1.60), P=0.03〕.

Cooking with solid fuels in urban and rural areas of China significantly increases the risk of hypertension in the elderly, as well as affects MAP. Reducing the use of solid fuels for cooking and promoting the use of clean fuels is a simple and effective measure in the prevention and control of hypertension.

Understanding the real experiences of elderly patients with chronic diseases during hospital-to-home transition and their expectations of care services can help promote the quality improvement of care services during the transition. In recent years, qualitative studies on real experiences of elderly patients with chronic diseases during the hospital-to-home transition and their experience of care services have gradually increased, however, the results of single qualitative study may not be generalizable and representative.

To systematically evaluate qualitative studies on the real experiences of elderly patients with chronic diseases during the hospital-to-home transition and their experience of care services.

In May 2022, PubMed, Web of Science Core Collection, EmBase, CINAHL, CNKI, and Wanfang Data Knowledge Service Platform were searched for the qualitative studies on the real experiences of elderly patients with chronic diseases during hospital-to-home transition and their experience of care services from inception to May 2022. Two researchers separately screened the literature and extracted data, evaluated the quality of included studies according to the Critical Appraisal Skills Programme (CASP) developed by evidence-based medicine center of University of Oxford. Meta synthesis was applied to integrate the results of the studies.

A total of 13 studies were included with 45 research results extracted, and 3 synthesized findings were integrated from 8 categories grouped by similar findings, including barriers to care services during hospital-to-home transition for elderly patients with chronic diseases; facilitators of care services during hospital-to-home transition for elderly patients with chronic diseases; expectations of elderly patients with chronic diseases for care services during hospital-to-home transition.

Hospital-to-home transition of elderly patients with chronic diseases is a challenging process, and there is still much room for improvement in the quality of care services during the transition. Families, communities, medical institutions, government, and society should actively improve the transition conditions for elderly patients at the individual, community, and social levels. The safe hospital-to-home transition of elderly patients with chronic diseases can be promoted by enhancing education for patients during transition, improving self-management abilities of patients, and providing nurse-led care services during transition.

Chronic kidney disease (CKD) is a serious risk to the health and longevity of the elderly, and hypertension is closely related to CKD. However, the studies on the correlation of blood pressure levels with the development and progression of CKD in older adults have shown inconsistent results.

To explore the association between blood pressure levels and the risk of CKD among the elderly in longevity areas of China.

From October 2021 to May 2022, a total of 989 older adults who underwent physical examination with biomedical indicators collected in 2012 were selected as subjects based on the subcohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) -Healthy Aging and Biomarkers Cohort Study (HABCS) . Age, gender, height, weight, blood pressure, blood lipid, blood glucose, routine blood and urine indicators were collected at baseline, and follow-up monitoring was conducted in 2014. Cox proportional hazards regression model was used to analyze the association between the blood pressure levels and the risk of CKD.

A total of 989 subjects were included in the study, with a median age of 79 (70, 88) years. The cumulative follow-up were 2 046 person-years, with an average follow-up time of (2.07±0.50) years. There were 183 new cases of CKD, the cumulative incidence of CKD was 18.5%〔95%CI (16.1%, 21.1%) 〕, and the incidence density was 89.4/1 000 person-years. During the follow-up, 9.8% (10/102) , 14.0% (47/335) and 22.8% (126/552) of the older adults in the normal blood pressure, high normal blood pressure and hypertension groups developed CKD, respectively, and the difference was statistically significant among the three groups (χ²=16.40, P<0.001) . The results of Cox regression showed that after adjusting for age, sex, BMI, waist circumference, calf circumference, fasting blood glucose, glycosylated serum protein, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, uric acid, superoxide dismutase, vitamind3, white blood cell count, red blood cell count, platelet count, blood urea nitrogen and history of diabetes, the older adults in the hypertension group had a higher risk of CKD〔HR (95%CI) =2.28 (1.13, 4.60) 〕 than those in the normal blood pressure group; the risk of CKD was 1.83 times〔95%CI (1.02, 3.29) 〕 higher in the older adults with baseline SBP≥140 mmHg (1 mmHg=0.133 kPa) than those with baseline SBP<120 mmHg, and the risk of CKD was 1.55 times〔95%CI (1.02, 2.35) 〕 higher in the older adults with baseline DBP≥90 mmHg than those with baseline DBP<80 mmHg (P<0.05) .

Hypertension is an independent risk factor for CKD in the elderly. It is particularly important to increase screening and prevention of CKD in older adults with predominantly elevated systolic blood pressure.

The scale and follow-up time of studies related to the association between sleep duration and all-cause mortality in middle-aged and older adults vary widely, and the results of studies such as correlations and recommended sleep duration remain controversial.

To explore the association between sleep duration and the risk of all-cause mortality in middle-aged and older adults.

From January to December 2022, the longitudinal study cohort was created based on the case ID numbers of coding manual combined with baseline and follow-up data of the China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Study (CLHLS) databases from January to December in 2022, which ultimately included 43 922 respondents. Social demographics, health status and health-related behaviors, sleep duration and death related information were extracted from CHARLS and CLHLS databases, recoding and variable transformations were performed according to the measurement and evaluation criteria of relevant indicators. The Kaplan-Meier method of Log-Rank test was used to plot survival curves, and the Cox proportional hazard regression model was used to explore the relationship between sleep duration and mortality risk in the middle-aged and older adults, followed by unrestricted cubic spline to observe the effect of the continuous-type variable of sleep duration on mortality risk.

Among 43 922 middle-aged and older adults with a median follow-up of 6 years and an average sleep duration of 7.32 h, 9 369 cases (21.33%) had sleep duration of≤5 h, 7 779 cases (17.71%) had sleep duration of >5-6 h, 295 cases (0.67%) had sleep duration of >6-7 h, 15 611 cases (35.54%) had sleep duration of >7-8 h, 2 567 cases (5.84%) had sleep duration of >8-9 h, 5 011 cases (11.41%) had sleep duration of >9-10 h and 3 290 cases had sleep duration >10 h (7.49%) . Kaplan-Meier survival analysis showed that middle-aged and older adults with moderate sleep duration (>6-7 h) had the highest probability of survival, and those with extra-long sleep duration (>10 h) had the lowest probability of survival. Cox regression model results showed that compared with middle-aged and older adults with sleep duration >10 h, middle-aged and elderly adults with sleep duration of ≤5 h〔HR (95%CI) =1.19 (1.09, 1.29) , P<0.05〕, >7-8 h〔HR (95%CI) =1.16 (1.08, 1.25) , P<0.05〕, >8-9 h〔HR (95%CI) =1.32 (1.19, 1.46) , P<0.05〕, and >9-10 h〔HR (95%CI) =1.12 (1.04, 1.22) , P<0.05〕 had increased risk of death. Restricted cubic spline showed an S-shaped non-linear association between sleep duration and risk of all-cause death (P=0.023) , with no significant association of sleep duration of 4.62-7.97 h with the risk of death, significant association of sleep duration <4.62 h and >7.97-10.00 h with all-cause mortality risk.

Middle-aged and older adults with moderate sleep duration had the highest probability of survival, so the recommended sleep duration for middle-aged and older adults is 5-7 h.

Previous studies have shown that self-rated health would be used as a simple assessment indicator for frailty, and individuals with poor self-rated health status are at higher risk of frailty. However, the association between self-rated health and frailty may be different and the effectiveness of self-rated health in frailty assessment may vary in apathetic older adults.

To explore the moderating role of apathy in the association between self-rated health and frailty among community-dwelling older adults, so as to provide theoretical guidance for the application of the self-rated health in the assessment of frailty in apathetic older adults.

From November 2021 to March 2022, a total of 384 community-dwelling older adults were selected as respondents by convenience sampling method, including 179 cases in Nanjing Dongshan Community and 205 cases in Lianyungang Qinghu Community. Questionnaire surveys were conducted using the General Information Questionnaire, Fried Frailty Phenotyp (FFP) , Geriatric Depression Scale (GDS-3) , and the self-reported health (SRH) . Generalized linear model was used to analyze the association between self-rated health and frailty of community-dwelling older adults. The model 1 of the SPSS macro program process compiled by Hayes was used to analyze the moderating role of apathy on the association between the self-rated health and frailty, with simple slope analyze performed and simple slope graphs plotted.

The median FFP and SRH item scores of 384 community-dwelling older adults were 1.00 (2.00) and 4.00 (1.00) , respectively, with the detection rate of apathy of 55.5% (213/384) . The results of the generalized linear model showed that the relationship between the self-rated health and frailty of community-dwelling older adults was significant (b=0.310, P<0.001) . The results of the moderating effect test showed that apathy played a moderating role in the relationship between self-rated health status and frailty in community-dwelling older adults (b=0.355, t=3.074, P=0.002) , and the results of simple slope analysis showed that the simple slope of the non-apathy group and apathy group was 0.100 (t=1.209, P=0.228) and 0.455 (t=5.206, P<0.001) respectively.

There is an association between self-rated health and frailty in community-dwelling older adults, and the application of the self-rated health can help community health workers assess frailty in older adults. Apathy plays a moderating role in the relationship between self-rated health and frailty. Compared with the non-apathetic older adults, the association between self-rated health and frailty is significant in apathetic older adults. Strengthening the self-rated health assessment of older adults is beneficial to the identification of their frailty.

In the context of aging society in China, the prevalence of Alzheimer's disease increases and multimorbidity becomes more common with years. However, the extensive investigations of Alzheimer's disease in Hunan province have not been reported adequately and the multimorbidity relationship between relevant diseases remains unclear.

To completely understand the prevalence of Alzheimer's disease in residents aged 65 or above in Hunan and analyze its multimorbidity relationships with 11 common chronic diseases.

The residents aged 65 years and above in 30 districts (counties), 60 streets (townships), and 180 neighborhood (village) committees in Hunan Province were randomly selected between April and May 2021 by using stratified multistage sampling method. Alzheimer's disease was diagnosed by a neurologist or psychiatrist using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), after using the Community Screening Interview for Dementia (CSI-D) or the 8-item ascertain dementia (AD8) as the screening tools. In addition, all respondents were investigated for the prevalence of hypertension, cerebrovascular disease, ischemic heart disease, rheumatoid arthritis, intervertebral disc disease, diabetes, gastroenteritis, chronic obstructive pulmonary disease, calculous cholecystitis, peptic ulcer and cancer.

A total of 5 979 residents were sampled, 5 616 of them completed the examinations and 785 (13.98%) were diagnosed with Alzheimer's disease. There were significant differences in the prevalence of Alzheimer's disease among respondents with different regions, gender, age, smoking history and presence of other chronic diseases (P<0.05). The total number of patients with other chronic diseases among all respondents was 5 606, with the top five diseases of hypertension〔2 205 (39.33%) 〕, intervertebral disc disease〔553 (9.86%) 〕, diabetes 〔526 (9.38%) 〕, cerebrovascular disease〔492 (8.78%) 〕, and ischemic heart disease〔467 (8.33%) 〕. The top five diseases in the dementia patients were hypertension〔325 (41.40%) 〕, cerebrovascular disease〔111 (14.14%) 〕, ischemic heart disease〔91 (11.59%) 〕, rheumatoid arthritis 〔89 (11.33%) 〕, and intervertebral disc disease〔81 (10.31%) 〕. The prevalence of dementia in patients with no chronic disease, with 1, 2, 3 or more types of other chronic diseases was 11.46% (214/1 867), 13.66% (309/2 262), 17.50% (176/1 006), and 18.26% (86/471), respectively. There were statistically significant differences in the prevalence of Alzheimer's disease between the subjects with and without gastroenteritis, rheumatoid arthritis, cerebrovascular disease, chronic obstructive pulmonary disease, and ischemic heart disease, respectively (P<0.05). Binary Logistic regression analysis showed that living in rural areas〔OR=2.048, 95%CI (1.655, 2.536) 〕, female〔OR=1.388, 95%CI (1.163, 1.655) 〕, aging〔OR=1.348, 95%CI (1.270, 1.431) 〕, and suffering from other chronic diseases〔OR=1.195, 95%CI (1.101, 1.297) 〕 were risk factors for the development of Alzheimer's disease in residents aged 65 years and above (P<0.05). The investigation results of timely medication taking in the patients with Alzheimer's disease showed that 12.79% (99/774) reported difficulties, 6.59% (51/774) needed help, and 2.97% (23/774) were unable to complete independently.

The prevalence of Alzheimer's disease in residents aged 65 years and above in Hunan Province increases with the number of other chronic diseases and correlates with multiple diseases. Great attention should be paid on the self-care ability and family care burden of Alzheimer's disease by society. The prevalence and multimorbidity of Alzheimer's disease were basically grasped by the investigation, in order to provide an objective basis for the formulation of policies on its prevention and treatment.

In the context of increasing population aging, maintaining the health of the elderly is the key to successful aging. Multimorbidity is an important factor threatening the health of the elderly, and its relationship with the health promotion behaviors of the elderly has been rarely reported.

To understand the multimorbidity patterns and distribution of health promotion behaviors among the elderly in Ningxia, analyze the relationship between multimorbidity patterns and health promotion behaviors in the elderly, so as to provide a reference for the development of management and intervention strategies for the health of elderly.

The population aged 65 years and above in Ningxia were selected as study subjects by using random cluster sampling method from January 2021 to July 2021, and surveyed by self-designed questionnaire〔including general information questionnaire, patient health questionnaire-9 (PHQ-9) , mini-mental state examination (MMSE) , health promoting lifestyle profile-Chinese version (HPLP-C) 〕. Multimorbidity patterns of the elderly was analyzed by association rules of Apriori algorithm, the correlation between multimorbidity and health promotion behaviors of the elderly was analyzed by multivariable Logistic regression analysis.

A total of 2 010 older adults aged 65 years and above were included, with the multimorbidity rate of 31.00% (623/2 010) . The most common binary multimorbidity pattern was coronary heart disease and hypertension〔25.36% (158/623) 〕, the most common ternary multimorbidity pattern was hypertension, coronary heart disease and stroke〔4.49% (28/623) 〕. The association rules revealed 16 patterns of multimorbidity, 15 of which were related to hypertension, 10 were related to coronary heart disease, and 7 were related to asthma. The multivariate Logistic regression analysis showed that compared with older adults with poor health promotion behaviors, those with general〔OR (95%CI) =0.364 (0.185, 0.714) 〕, good〔OR (95%CI) =0.488 (0.251, 0.948) 〕, excellent〔OR (95%CI) =0.426 (0.213, 0.853) 〕health promotion behaviors had a lower risk of multimorbidity (P<0.05) . HPLP-C physical activity〔OR (95%CI) =0.960 (0.925, 0.997) 〕and stress management〔OR (95%CI) =0.963 (0.938, 0.989) 〕dimension scores in older adults were negatively associated with the occurrence of multimorbidity; HPLP-C health responsibility〔OR (95%CI) =1.038 (1.013, 1.063) 〕dimension score was positively associated with the occurrence of multimorbidity.

The multimorbidity patterns of the elderly in Ningxia are complex, and there is an association between health promotion behaviors and occurrence of multimorbidity. The risk of multimorbidity can be reduced by interventions such as encouraging the elderly to practice health promotion behaviors and improve their lifestyles.

Polypharmacy is common among older patients with common diseases. There is a strong need for evaluation management and consultation services of polypharmacy among older patients from medical workers, patients and their families. However, the functional design of how to scientifically and accurately manage services and consultations based on Internet technology for different categories of users has not been adequately studied.

To conduct investigation on the design of the service functions and methods of platform for evaluation management and consultation services of polypharmacy among older patients for healthcare professionals, taking the Internet services oriented to improve irrational drug use and reduce drug-related adverse events in older patients as a new idea.

Healthcare professionals from medical institutions participating in the National Key Research and Development Program (Multiple Drug Use Risk Management for Common Diseases of the Elderly) from 2021-02-20 to 2021-03-06 were selected as research subjects, the self-designed Questionnaire on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of Healthcare Professionals focusing on the necessity, operation mode and function of the platform were distributed. Principal component analysis was used to extract common factors for each platform function, and further factor rotation was performed using Kaiser's normalized maximum variance method, and the mean values of each factor score were ranked to explain the relative importance of each factor.

A total of 548 valid research questionnaires were collected in this study with recovery rate of 100.00%. The cumulative total variance explained by the third factor in the sum of squared factor extracted for the 8 platform functions (patient compliance evaluation, prescription appropriateness evaluation, prescription economy evaluation, medication administration notification and reminder, medication administration precautions, medication administration record management, potential medication problem reminder, adverse drug reactions record and analysis) was 77.036%. The 8 platform functions were finally extracted into 3 factors, named as reminder factor (F1) , evaluation factor (F2) , and adverse analysis factor (F3) , and the ranking of the mean values of the 3 factors in descending order was F1 (mean factor score of 2.977) , F2 (mean factor score of 0.118) , and F3 (mean factor score of 0.112) .

From the perspective of healthcare professionals, reminder, evaluation and adverse analysis are the main operation modes and core functions of the platform for evaluation management and consultation services of polypharmacy among older patients, with reminder-related functions as the most important functions, which will provide substantial help to ensure the effective contribution of the platform to the construction of polypharmacy risk monitoring and control system for common diseases of the elderly in China.

Our research team has previously conducted investigation on platform for evaluation management and consultation services of polypharmacy among older patients needs of healthcare professionals to ensure a close association between the design and development of the platform and actual needs. However, the awareness of the risks associated with polypharmacy in the elderly and needs of manage services and consultations based on Internet among general population have been rarely reported in China.

To understand the awareness of platform for evaluation management and consultation services of polypharmacy among older patients of general population, so as to further explore the operation mode of the platform and provide guidance for its improvement and refinement.

The self-designed Questionnaire on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of General Population focusing on the operation mode and importance of each function were distributed to the users of HeFen Club platform of China Mobile from 2021-09-29 to 2021-10-09, using HeFen Club WeChat public platform of China Mobile as the investigation platform and web-based questionnaire survey for general population as the investigation method. Principal component analysis was used to extract common factors for each platform function, and Kaiser's normalized maximum variance method was further used to rotate the factors and rank the mean scores of each factor to explain the relative importance of each factor.

A total of 29 502 valid questionnaires were collected in this study with a recovery rate of 94.89%. The cumulative total variance explained by the fourth factor in the sum of squared factor extracted for the 12 platform functions (patient compliance evaluation, prescription appropriateness evaluation, prescription economy evaluation, medication administration notification and reminder, medication administration precautions, medication administration record management, potential medication problem reminder, manual real-time consultation, manual non-real-time consultation, self-service query, medication administration reminder, and record analysis) was 76.791%; The 12 platform functions were finally extracted into 4 factors, named as reminder factor (F1) , evaluation factor (F2) , query and record factor (F3) and consultation factor (F4) , and the ranking of the mean values of the 4 factors in descending order was F2 (mean factor score of 0.507) , F1 (mean factor score of 0.457) , F3 (mean factor score of 0.430) , and F4 (mean factor score of 0.253) .

Nearly 90.00% of the respondents believe that older adults with multiple common diseases are at risk of polypharmacy and need a platform for management and consultation services of polypharmacy. From a public perspective, reminder, evaluation, querying and record, consultation are the main operation modes and core functions of the platform for evaluation management and consultation services of polypharmacy among older patients.

The advantages of mobile smart healthcare in screening, intervention, treatment, and management of cardiovascular diseases have become increasingly prominent in recent years. The application value of wearable single lead electrocardiogram equipment in the early screening and diagnosis of arrhythmia patients out of the hospital has been recognized by scholars and clinical workers. However, its application in risk screening and long-term follow-up management of chronic disease patients in primary care is limited by the single function of the cloud platform led and matched by it.

To explore the application value of mobile smart healthcare in the prevention and control of cardiovascular disease risk in elderly patients with chronic disease in primary care from the perspective of chronic disease prevention and control and using wearable single lead electrocardiogram equipment as carriers, based on hierarchical medical system.

A total of 3 000 patients with chronic disease aged above 65 years admitted to primary care institutions in Ningxia from January 2022 to August 2022 were selected as research subjects, including 1 202 males and 1 798 females with an average age of (71.3±5.0) years. The baseline data were recorded by primary care physicians through mobile phone APP and cloud platform of patient management, 72-hour ECG data collected by wearable single lead electrocardiogram equipment were also uploaded to cloud platform of patient management. Analysis of data and risk stratification for arrhythmia, heart rate variability (HRV) and obstructive sleep apnea hypopnea syndrome (OSAHS) were performed by professional electrocardiographers, and the corresponding marks on the cloud platform for the data with low, medium and high risk of cardiovascular disease were ticked according to the stratification results of the three analysis methods. The cloud platform notifies primary care physicians of high and medium risk data in the form of SMS for the management of different processes of patients. The number of detected cases with different risk stratification, the number of detected cases and rates of management according to the process among patients with low, medium and high risk of cardiovascular disease were counted.

Arrhythmias were detected in 1 526 (50.87%), 1 349 (44.97%), and 125 (4.17%) cases consistent with negativity, positivity, and significant positivity, respectively; HRV was mildly, moderately, and severely reduced in 2 330 (78.50%), 630 (21.23%), and 8 (0.27%) cases, respectively; OSAHS was consistent with mild, moderate, and severe abnormalities in 1 769 (59.60%), 573 (19.31%), and 626 (21.09%) cases, respectively. The comprehensive risk of cardiovascular disease was low, moderate, and high in 744 (24.80%), 1 640 (54.67%), and 616 (20.53%) patients, respectively. The rates of management according to the process in patients with high, medium and low comprehensive risk of cardiovascular disease were 94.49% (703 cases), 88.10% (1 445 cases) and 100% (616 cases), respectively.

The elderly patients with chronic disease in primary care with combined application of mobile smart healthcare technology and arrhythmia, HRV, OSAHS analysis methods to the prevention and control of cardiovascular diseases have higher detection rate of cardiovascular disease risk and management rate, which is conducive to the establishment of a cardiovascular disease prevention and control system for them.

With the population aging, mental health of the middle-aged and elderly adults is of great concern, especially in middle-aged and elderly women. Compared with urban women, rural women are more likely to suffer from mental diseases due to their poorer health status, lower education level and backward living conditions, however, the accessibility of mental health services among them is low.

To understand the prevalence of depression among middle-aged and elderly women in rural China and analyze its influencing factors, in order to provide empirical evidence for improving the mental health of middle-aged and elderly women.

From May to July 2021, the follow-up data of the 2018 China Health and Retirement Longitudinal Study (CHARLS) was extracted, and rural women aged 45 years and above were selected as the study subjects (n=6 736) . The scores of the simplified version of the Center for Epidemiologic Studies Depression Scale (CES-D) were used to determine the depression status of rural middle-aged and elderly women. Chi-square tests and multivariate Logistic regression model were used to analyze the influencing factors of the occurence of depressive symptoms among rural middle-aged and elderly women (including individual characteristics, health behaviors, social participation and utilization of medical services utilization) .

The CES-D score of 6 736 rural middle-aged and elderly women was (20.0±6.9) , 42.46% (2 860/6 736) of whom had depressive symptoms. The results of multivariate Logistic regression analysis showed that satisfication with health status〔OR (95%CI) =0.40 (0.36, 0.45) 〕, sleep duration ≥6 h〔OR (95%CI) =0.48 (0.43, 0.54) 〕, Internet use〔OR (95%CI) =0.63 (0.50, 0.80) 〕 and satisfication with life 〔OR (95%CI) =0.25 (0.21, 0.30) 〕 were correlated with lower risk of depression; hysical disability〔OR (95%CI) =1.41 (1.16, 1.71) 〕, suffering from chronic diseases〔OR (95%CI) =1.35 (1.21, 1.50) 〕, receiving outpatient services within 1 month〔OR (95%CI) =1.25 (1.09, 1.43) 〕 and hospitalization services within 1 year〔OR (95%CI) =1.31 (1.13, 1.52) 〕 were correlated with higher risk of depression.

Based on the results of this study, the depression status of middle-aged and elderly women in rural China is relatively severe and affected by individual characteristics, health behaviors, social participation, and the medical services utilization. It is recommended that governments and civil affairs departments at all levels pay close attention to the mental health of rural middle-aged and elderly women, especially through the intervention and prevention from multiple dimensions such as health promotion and education, medical service quality, and accessibility of information, in order to promote the construction of healthy villages and process of health aging in China.

There are many types of assessment tools for dementia patients both domestically and internationally. However, assessments using single-dimensional measurement tools often have limitations, and there is still a lack of reports on comprehensive assessment tools specifically for dementia patients in current. Based on this, the comprehensive assessment tools for the elderly with dementia are reviewed both domestically and internationally, 8 assessment tools from the perspectives of demand and function for the elderly with dementia are summarized, and the content, reliability and validity, application of each tool are discussed in this paper, in order to provide reference for the use and development of assessment tools for the elderly with dementia in China.

Important predictive value of platelet-lymphocyte ratio (PLR) for adverse outcomes of cardiovascular disease has been proved in previous studies, however, the predictive value of PLR for short-term prognosis in elderly patients with acute myocardial infarction (AMI) remains to be explored.

To determine the predictive ability of PLR for mortality risk during hospitalization in elderly patients with AMI.

The medical history data of 1 423 elderly patients with AMI treated in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 was retrospectively collected, mainly including gender, age, BMI, blood pressure classification, glycated hemoglobin, platelet count, neutrophil count, lymphocyte count, estimated glomerular filtration rate, lipid related indices, the combination of heart failure and diabetes, the use of statins and antiplatelet agents during hospitalization, with the final outcome defined as all-cause death during hospitalization. The included patients were divided into the non-death group (n=1 315) and death group (n=108) according to the occurrence of death. ROC curve was used to determine the predictive ability of PLR for in-hospital mortality risk in elderly patients with AMI, and the clinical application value of PLR and its combined indicators by decision curve analysis (DCA) .

There were significant differences in age, BMI, PLR, white blood cell count, neutrophil count, lymphocyte count, red blood cell count, hemoglobin, fasting blood glucose level, AST, TG, CTNI, eGFR grade, proportion of heart failure, proportion of antiplatelet drugs, and proportion of lipid-lowering drugs between the death group and the non-death group (P<0.05). The area under the ROC curve of PLR for predicting the risk of in-hospital mortality in elderly AMI patients was 0.661 (P<0.001) ; AUC when PLR was combined with CK-MB or CTNI was 0.705 and 0.779 (P<0.001), respectively. The results of decision curve analysis based on Bootstrap method showed that the risk threshold of PLR between 6% and 82% and the risk threshold of PLR combined with CTNI between 2% and 86% could produce large net benefits and have clinical application value.

PLR can effectively predict the risk of in-hospital death in elderly patients with AMI, and this predictive ability is significantly improved after combined CTNI.

Esophageal cancer is one of the most aggressive gastrointestinal tumors. Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities, while the failure to improve dysphagia in the short term will seriously affect the nutritional status, life quality and prognosis of patients.

To explore the safety and efficacy of image-guided photodynamic therapy (IGPDT) under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma.

A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective, single-arm, self-control study. The upper boundary of the lesion was located by endoscopy and marked with metal tissue clips, the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment, the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before, 1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 (NRS 2002) score, hemoglobin, BMI, albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale (SWAL-QOL) was used to evaluate the quality of life in patients.

All patients achieved partial response (PR) at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation (P<0.001). BMI, albumin and prealbumin at 2 months after operation were significantly increased than that before operation (P<0.05). The total score and scores of different dimensions in SWAL-QOL at 2 months after operation were significantly higher than those before operation, including psychological burden, appetite, eating time, fear of eating and swallowing symptoms (P<0.05). 92% (22/24) of the patients presented with grade 1-2 mild fever, and most of them could be relieved on their own. 83% (20/24) of the patients presented with grade 1-2 pain at the site of operation at 1-2 days after surgery but could be relieved by themselves. No esophageal fistula occurred in all patients during the operation, and no serious adverse effects of grade 3 or above occurred.

IGPDT has the advantages of easy operation, excellent efficacy and safety, and short-term improvement of nutritional status in patients, which can be used as a novel photodynamic therapy for patients with severe obstruction esophageal carcinoma cannot be passed by endoscopy.

With the aging and longer survival of the population, comorbid chronic diseases is increasingly common. The variety and complexity of diseases pose challenges to the health management of the elderly. There is a relative lack of multimorbidity pattern researches in China, which are necessary issues for research.

To investigate the patterns of coexistence of common multiple chronic conditions among the elderly in China, in order to help policymakers, researchers, and clinicians better understand the current status of multimorbidity among Chinese elderly.

Data on the demographic characteristics and health status of 14 chronic diseases were extracted from the respondents aged 60 years and above in the China Health and Retirement Longitudinal Study (CHARLS) 2018, association rules, cluster analysis, principal component analysis, latent class analysis were used to explore the multimorbidity patterns of Chinese elderly, and the results of different methods were compared.

The data from a total of 10 800 respondents were eventually included, there were differences among the patterns obtained by four methods. However, the consistent multimorbidity patterns were identified: hypertension, diabetes or elevated blood glucose, dyslipidemia; chronic lung disease and asthma; arthritis or rheumatism, stomach diseases or digestive diseases; stroke, memory-related diseases.

The consistent patterns obtained by different methods contain chronic diseases with significant relationships of etiologies. The reasons of differences in results are complex etiologic relationships and different method principles.

Dyslipidemia is the most important and causal independent risk factor for atherosclerotic cardiovascular disease (ASCVD) . The prevalence of dyslipidemia in elderly residents in Guangdong Province is high, and it is urgent to analyze the specific prevalence of dyslipidemia and its influencing factors among the elderly, and to carry out targeted preventive and control measures for dyslipidemia.

To investigate the epidemiological status of dyslipidemia and its risk factors among elderly residents included in the national basic public health service in Yuexiu District, Guangzhou.

A total of 41 469 elderly residents aged 65 years and above with complete important variables were selected as subjects from the information system of community health service center in Yuexiu District, Guangzhou City in 2020, the 2020 health checkup data was used to describe the epidemiological characteristics of the included patients such as basic information, BMI and blood lipid levels. Restricted cubic spline (RCS) fitting Logistic regression model was used to analyze the relationship between age, BMI and the prevalence of dyslipidemia.

The prevalence of dyslipidemia in 41 469 elderly residents was 53.65% (22 247/41 469) , with a standardized prevalence of 53.89%. The prevalence of hypercholesterolemia (HTC) , hypertriglyceridemia (HTG) , mixed hyperlipidemia and low high-density lipoprotein cholesterol was 21.43%, 16.50%, 14.51% and 3.80%, with the standardized prevalence of 21.57%, 16.53%, 14.61%, 3.78%, respectively. Multivariate Logistic regression analysis showed that gender, age, education level, exercise status, and BMI were all influencing factors for dyslipidemia in elderly residents, among which female, low age group, and high BMI were risk factors for dyslipidemia in elderly residents (P<0.05) . The results of RCS fitting showed a non-linear relationship between age, BMI and the prevalence of dyslipidemia in elderly residents. The overall prevalence of dyslipidemia in elderly residents showed a decreasing trend with the increase of age. The risk of dyslipidemia showed on increasing and then decreasing trend with the increase of BMI, the OR increased significantly at low BMI, while decreased at high BMI.

The prevalence of dyslipidemia is relative high among elderly residents aged 65 years and above included in the national basic public health services in Yuexiu District, Guangzhou. The prevalence of dyslipidemia in the elderly group tends to decrease with the increase of age, and the risk of dyslipidemia prevalence tends to increase and then decrease with the increase of BMI, suggesting special features in the management of dyslipidemia among the elderly, the analysis of risk factors for dyslipidemia in the elderly should be focused on and early preventive and control measures should be carried out.

Falls among older adults will cause a heavy burden on society and families. The development of effective falls prevention intervention policies for community-dwelling older adults is an important initiative to address this global public health problem.

To analyze and compare the content composition, key initiatives and implementation strategies of current falls prevention intervention policies for community-dwelling older adults in different countries from the perspective of policy tools.

Six countries in Asia, North America, and Europe, including Japan, Singapore, Thailand, the United States, Germany, and Russia, were selected as sample countries according to the degree of population aging and economic income level. Refer to the websites of relevant government departments such as the Ministry of Health, the Center for Disease Control and Prevention and directly affiliated institutions, as well as websites of nongovernmental organizations, such as Prevention of Falls Network Europe, National Council On Aging, U.S., Association of Fall Prevention, Japan, and National Association of Statutory Health Insurance Funds, Germany, the national policy documents of prevention interventions for community-dwelling older adults from January 2010 to June 2022 were searched by using "older adults" "fall/drop/accidental injuries" "prevention" as keywords. The text analysis was performed from the dimensions of policy tools such as demand-side type, supply-side type and environmental-side type, and injury prevention strategies such as education prevention strategies and evaluation strategies.

Among the 24 policy documents, there were 212 coded targets in the dimension of policy tools, with environmental-side type, supply-side type and demand-side type policy tools accounting for 45.3% (96/212), 40.6% (86/212) and 14.1% (30/212), respectively. Among high-income countries, the public service tools under supply-side type policy tools were mostly applied in the United States and Germany, accounting for 40.5% (17/42) and 13.8% (8/58) ; the infrastructure construction tools under supply-side type policy tools were focused in Singapore〔24.1% (7/29) 〕. Among low and middle income countries, the environmental-side type policy tools were mostly applied in Russia and Thailand, accounting for 51.3% (20/39) and 55.6% (10/18), respectively. Public service was mostly applied among the supply-side type policy tools, accounting for 17.5% (37/212) ; technical standard was mostly applied among the environmental-side type policy tools, accounting for 10.8% (23/212) ; medicare payment was mostly applied among the demand-side type policy tools, accounting for 4.7% (10/212). In addition, there were 105 coded targets in the dimension of injury prevention strategies, with the education prevention strategies accounting for the highest proportion of 31.4% (33/105), the engineering strategy accounting for the lowest proportion of 5.7% (6/105). High-income countries are at the stage of multi-sectoral collaborative policy implementation, low and middle income countries are at the stage of policy implementation by the Ministry of Health stage.

Six countries focus on public service and infrastructure development under supply-side type policy tools; the application of demand-side type policy tools can be summarized as intervention services managed by medical insurance, intervention projects supported by financial funds, service purchases attracted by price subsidies, planning, organization, advocacy, and standard setting of environmental-side type policy tools. In combination with the priorities and specific measures of the six countries, it is suggested to learn from advanced experience in improving public services, strengthening evidence-based projects, standardizing technical standards, supporting financial incentives, expanding medical insurance programs, and providing price subsidies, thus further optimizing falls prevention intervention policies for community-dwelling older adults.

The continuous increase in numbers of people with osteoporosis, and individuals with low bone mass in the community, brings severe challenges to the prevention and treatment of osteoporosis in the community.

To investigate the basic conditions related to the prevention and control of osteoporosis in communities, including the basic process and cost of enrolling the target population, and the prevalence and risk factors of osteoporosis in the target population, so as to provide evidence for supporting a general practice team to develop precise osteoporosis prevention and control measures.

This study selected 322 cases (including outpatient patients and older physical examinees) from Waitan Community Health Service Center, Shanghai from May to August 2021. General information, bone density test results and risk factors of osteoporosis were collected by a questionnaire.

The cost of enrolling the target population in the community was 57.344 yuan per person. Among the 322 cases, 27 (8.4%) had normal bone mass, 157 (48.8%) had low bone mass, and 138 (42.8%) had osteoporosis. The prevalence of bone density abnormalities (low bone mass and osteoporosis) reached 91.6%. There were statistically significant differences in gender ratio and BMI among normal bone mass, low bone mass and osteoporosis groups (P<0.05). The average bone mineral density (BMD) values of normal bone mass, low bone mass and osteoporosis groups were (-0.72±0.27) AU/mm³, (-1.88±0.38) AU/mm³, and (-3.17±0.53) AU/mm³, respectively. In terms of exercise habits, the prevalence of individuals doing little exercise in normal bone mass, low bone mass and osteoporosis groups was 37.0% (10/27), 49.7% (78/157) and 64.5% (89/138), respectively. In terms of exercise intensity, the prevalence of individuals exercising at moderate-intensity in normal bone mass, low bone mass and osteoporosis groups was 74.1% (20/27), 79.6% (125/157) and 80.4% (111/138), respectively. Three groups had no significant differences in the other osteoporosis risk factors, such as surgical treatment history, smoking history, allergy history and disease history. There was also no significant intergroup difference in dietary habits. Of all cases, 48.8% (157/322) never drank beer, liquor and red wine, 32.0% (103/322) drank coffee 4-6 times per week, and 31.4% (101/322) ate pickled vegetables, smoked foods, or sauces 4-6 times per week.

The community is a favorable setting for conducting prevention, treatment and clinically research programs regarding osteoporosis owing to short participant enrollment period and low cost. As the exercise and eating habits of the elderly in the community are unhealthy, the general practice team should accurately guide them to rapidly improve their dietary structure and develop a healthy exercise habit according to their own status, by which the onset and progression of osteoporosis can be proactively controlled.

The contribution of geriatric health examination services of national essential public health services to the detection of abnormal health conditions in the elderly and the awareness of examination results of the elderly has been rarely reported in the current studies.

To investigate the abnormal detection of several common diseases including abnormal blood pressure, abnormal blood glucose, overweight and obesity, anemia, fatty liver disease, gallstones or cholecystitis in the health examination of the older adults aged 65 years and above.

The older adults aged 65 years and above who visited 20 primary care institutions in 5 cities of 3 provinces in eastern, central and western China were selected as study subjects (excluding those with unclear health examination results in this year) from November to December 2019 by using a multi-stage stratified sampling method, and divided into the general older adults (without hypertension or diabetes), older adults with hypertension, older adults with diabetes. A one-on-one questionnaire survey was conducted on all respondents (The questionnaire included the general demographic characteristics of the respondents and the abnormal detection in the health examination of the elderly) .

Among 3 018 older adults, 2 033 (67.36%) reported abnormalities in the health examination. There were statistically significant differences in the abnormal detection rates of health examination for the older adults with different types of residence, population, and household registration (P<0.05). Among 3 018 older adults, 1 174 (38.90%) self-reported abnormal blood pressure detection, 747 (24.75%) self-reported abnormal blood glucose detection, 719 (23.82%) self-reported dyslipidemia detection, 445 (14.74%) self-reported fatty liver detection, 393 (13.02%) reported overweight and obesity detection, 238 (7.89%) reported gallstones or cholecystitis detection, and 60 (1.99%) reported anemia detection. Abnormal blood pressure was detected in 49.13% of the older adults diagnosed with hypertension during the annual health examination, with the blood pressure control rate of 50.87%. Abnormal blood glucose was detected in 60.48% of the older adults diagnosed with diabetes during health examination with the control rate of blood glucose of 39.52%. Multivariate Logistic regression analysis showed that the detection rate of abnormal blood pressure was 2.57 times〔95%CI (2.01, 3.29) 〕 higher in the older adults with diabetes than in the general older adults; the detection rate of dyslipidemia was 1.64 times〔95%CI (1.29, 2.08) 〕 and 1.42 times〔95%CI (1.10, 1.84) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of overweight and obesity was 2.79 times〔95%CI (1.94, 4.00) 〕 and 2.64 times〔95%CI (1.80, 3.87) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of fatty liver was 2.10 times〔95%CI (1.55, 2.85) 〕 higher in the the older adults with hypertension than the general older adults; while the detection rate of anemia was 0.25 times〔95%CI (0.13, 0.47) 〕 and 0.47 times〔95%CI (0.25, 0.86) 〕 higher in the older adults with hypertension and diabetes than in the general older adults; the detection rate of dyslipidemia, gallstones or cholecystitis was 0.76〔95%CI (0.64, 0.90) 〕and 1.32〔95%CI (1.01, 1.73) 〕 times higher in the rural older adults than the urban older adults, respectively (P<0.05) .

The physical examination program for the elderly in the national essential public health services plays an important role in early detection and wareness of health problems.

"Everyone enjoys essential medical and health services" and "achieving health equity" are core goals of the new healthcare reform initiated in 2009 in China. Rural middle-aged and elderly people are key target groups of healthy aging promotion, but there are few longitudinal studies on the equality in their use of health services during 10 years since the beginning of the new healthcare reform.

To understand the changes in health service utilization among middle-aged and elderly people in rural areas of Ningxia during 2009 to 2019, and to explore the factors affecting the equity of health service utilization.

The information related to health service utilization in middle-aged and elderly people aged 45 years and above in rural mountainous areas of southern Ningxia was obtained from the baseline survey conducted in 2009 and subsequent follow-up surveys in 2015 and 2019. The changes of health service utilization of this population before and after the new healthcare reform were analyzed by the χ² test. The concentration index (CI) and decomposition of CI technique were used to measure the equity in health service utilization and explore its associated factors.

The two-week consultation rates in these middle-aged and elderly people in 2009, 2015 and 2019 were 13.14% (973/7 406), 10.14% (943/9 302), and 12.75% (1 066/8 360), respectively, showing statistically significant difference (χ²=46.340, P<0.001). The hospitalization rates in them in 2009, 2015, and 2019 were 13.27% (983/7 406), 18.07% (1 681/9 302), and 22.93% (1 917/8 360), respectively, with statistically significant difference (χ²=245.657, P<0.001). The first leading cause of non-seeking healthcare for an illness within two weeks was financial difficulties〔58.35% (353/605) 〕in 2009, and was self-perceived mildness of symptoms in 2015〔34.47% (121/351) 〕 and 2019〔34.21% (117/342) 〕. In the three surveys, financial difficulties were the top reason for those needing hospitalization but not being hospitalized, accounting for 83.82 % (228/272) in 2009, 60.98% (75/123) in 2015, and 41.22% (54/131), respectively. The values of CI of the two-week consultation rate in the three surveys were 0.056 5, 0.012 8, and 0.018 6, respectively, and those of the hospitalization rate were 0.045 8, -0.011 0, and 0.002 0, respectively. Economic level, chronic disease, age, and family size were main contributing factors to the inequity in health service utilization.

A significant increase was seen in the use rate of inpatient service utilization in this population during the 10 years after the healthcare reform, but their utilization rate of outpatient health services needed to be improved. Health service utilization tended to return to equity, but it was still higher in high-income individuals. Economic level was the primary factor affecting the equity of health service utilization.

As global aging advances, the number of people with disability is increasing. Disability seriously affects quality of life and increases the burden caused by healthcare expenditure. Most domestic studies focus on disabilities in middle-aged and elderly people, but there is a lack of longitudinal studies on the fairness of health service utilization and changes in its associated factors in rural middle-aged and elderly people with disability.

To analyze the fairness of health service utilization and major associated factors in middle-aged and elderly people with disability in rural mountainous areas of southern Ningxia.

This study used data from three waves of the Rural Household Health Survey (including the baseline survey in 2009 and two follow-up surveys in 2015 and 2019), and selected middle-aged and elderly adults (≥55 years old) with disabilities from the surveyees as the participants. The health service utilization equity of sample population before the new healthcare reform launched in 2009 and during 10 years after the reform was analyzed by using concentration index, and factors affecting the equity were analyzed by decomposing the concentration index.

We selected 1 351 cases from the surveyees of 2009, 1 521 cases from the surveyees of 2015, and 685 cases from the surveyees of 2019. The concentration index for two-week visit rate in the participants was 0.119 9 for 2009, 0.052 1 for 2015, and 0.060 9for 2019. Women (CI=0.108 2, -0.084 1) had higher level of inequalities in heath service utilization than men (CI=-0.022 9, 0.029 5) in 2015, 2019 year. Upper-middle income and high income were major factors contributing to inequalities in health service utilization in this population in 2009, explaining 3.626 9% and 2.596 5% of the inequalities, respectively. In 2015, in addition to economic factors, marital status (married), degree of education (primary) and household size (moderate) were another major factor contributing to inequalities in health service utilization, explaining 0.478 6%、0.398 4%、-0.339 2% of the inequalities, respectively. And in 2019, besides economic factors, household size (advanced) and Age (70-74 years old) were major factor contributing to inequalities in health service utilization, explaining -0.953 4%、0.694 3% of the inequalities, respectively.

Rich-related inequalities were found in the use of care for an ill within two weeks in this group of people, in Ningxia the past decade of the new medical reform. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, household size, economic income, and other factors interact in multiple ways. Moreover, the strength of association age, vocational type inequalities in health service utilization in women was greater than that in men.

The prevalence of comorbidity in the elderly is showing a rising trend year by year with the acceleration of population aging. Comorbidity is a key risk factor for frailty in the elderly. Then frailty only increases the risk of adverse health outcomes for patients with comorbidity, but also significantly increases their family medical expenses. It has a certain guiding value for the management of comorbidity to identify the frailty conditions of elderly patients with comorbidity as early as possible.

To systematically review the prevalence of frailty in elderly patients with comorbidity.

CNKI, VIP, CBM, WanFang, PubMed, EmBase, Web of Science and Cochrane Library were searched in December 2021 for the investigation studies on the current status of frailty in elderly patients with comorbidity published from inception to December 4, 2021. Two researchers performed literature screening and data extraction independently. The cross-sectional study quality rating scale and Newcastle-Ottawa Scale (NOS) recommended by Agency for Healthcare Research and Quality (AHRQ) were used to assess the risk of bias of the included studies and Stata 14.0 was adopted for meta-analysis.

A total of 25 studies involving 16 062 elderly patients with comorbidity were included. Meta-analysis results showed that the prevalence of frailty and pre-frailty in elderly patients with comorbidity was 26.7%〔95%CI (21.9%, 31.5%) 〕and 47.7%〔95%CI (43.9%, 51.4%) 〕. Subgroup analysis showed that the prevalence of frailty in older adults with≥2, ≥3, ≥4, and≥5 chronic diseases was 25.1%〔95%CI (19.3%, 30.8%) 〕, 27.4%〔95%CI (13.7%, 41.0%) 〕, 60.7%〔95%CI (29.0%, 92.4%) 〕, and 23.5%〔95%CI (8.6%, 38.5%) 〕, respectively. The prevalence of frailty in elderly patients with comorbidity in Oceania (52.1%) and Asia (31.3%) were significantly higher than Europe (16.9%) and South America (13.2%) . The prevalence of frailty in elderly patients with comorbidity in hospital (26.2%) was significantly higher than community (23.2%) . The prevalence of frailty in elderly patients with comorbidity screened by Clinical Frailty Scale (CFS) , Fried frailty phenotype scale and FRAIL Scale was 42.8%〔95%CI (38.4%, 47.1%) 〕, 22.2%〔95%CI (17.8%, 26.7%) 〕and 8.5%〔95%CI (6.3%, 10.6%) 〕, respectively. The prevalence of frailty in elderly patients surveyed in 2001—2010, 2011—2015, and 2016—2020 was 21.0%〔95%CI (13.2%, 28.8%) 〕, 19.0%〔95%CI (13.1%, 24.8%) 〕and 37.7%〔95%CI (22.6%, 52.9%) 〕, respectively.

The prevalence of frailty in elderly patients with comorbidity is gradually increasing, with differences by number of co-morbidities, continents, assessment tools and study sites. Therefore, relevant personnel should pay attention to early screening of frailty in elderly patients with comorbidity and take timely measures to prevent the development of frailty in elderly patients with comorbidity.

The elderly are a priority population for COVID-19 vaccination. COVID-19 vaccination can effectively reduce the risk of developing severe and critically ill patients or even death in COVID-19 patients. However, the current vaccination rate of the elderly in China is relatively low, and the COVID-19 vaccination behavior among the elderly has been rarely reported in current studies.

To investigate COVID-19 vaccination behavior and its influencing factors among the elderly in China, and to provide a reference for improving the COVID-19 vaccination rate of the elderly.

A total of 1 323 older adults aged 60 years and above in Wujin District of Changzhou City, Zhongmu County of Zhengzhou City, Chengzhong District of Xining City and Linkou County of Mudanjiang City were selected as research subjects from August 3 to August 14 in 2022 by using a stratified random sampling method and investigated by self-designed questionnaires. Binary Logistic regression analysis was used to explore the influencing factors of the first dose of COVID-19 vaccination, full course of COVID-19 vaccination, and booster dose of COVID-19 vaccination.

96.60% (1 278/1 323) of the elderly received the first dose of COVID-19 vaccine, 91.76% (1 214/1 323) completed the full course of COVID-19 vaccination, and 79.67% (1 054/1 323) received the booster dose of COVID-19 vaccine. The results of binary Logistic regression analysis showed that compared with the older adults aged 60-64 years, the older adults aged 75 years and above were less likely to receive the first dose of the COVID-19 vaccine〔OR (95%CI) =0.27 (0.11, 0.62), P<0.05〕; compared with the older adults with chronic disease, the older adults without chronic disease were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =2.07 (1.12, 3.84), P<0.05〕; the older adults with higher levels of perceived benefit were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =1.39 (1.07, 1.79), P<0.05〕. Compared with the older adults aged 60-64 years, who maintained regular physical exercise, those aged 75 years and above〔OR (95%CI) =0.34 (0.19, 0.59), P<0.05〕, who did not maintain regular physical exercise〔OR (95%CI) =0.64 (0.42, 0.96), P<0.05〕were less likely to complete the full course of vaccination; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to complete the full course of the COVID-19 vaccination〔OR (95%CI) =1.59 (1.05, 2.40), P<0.05〕. Compared with older adults aged 60-64 years and from the central region, the older adults aged 75 years and above〔OR (95%CI) =0.55 (0.36, 0.86), P<0.05〕and from the eastern region〔OR (95%CI) =0.47 (0.34, 0.64), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.54 (1.15, 2.06), P<0.05〕; older adults with higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.06 (1.00, 1.11), P<0.05〕. Subgroup analysis showed that compared with the older adults with chronic diseases aged 60-64 years, from the central region, older adults with chronic diseases aged 75 years and above〔OR (95%CI) =0.35 (0.19, 0.65), P<0.05〕, from the eastern region〔OR (95%CI) =0.49 (0.29, 0.83), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; older adults with chronic diseases who had higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.09 (1.01, 1.18), P<0.05〕. Compared with the older adults from the central region without chronic diseases, the older adults from the eastern region without chronic diseases were less likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =0.44 (0.29, 0.68), P<0.05〕.

More attention should be paid to the elderly who are senior and with chronic diseases in the process of COVID-19 vaccination. The vaccination rate of the elderly should be further increased by strengthening the publicity of COVID-19 vaccine knowledge.

Intellectual activities such as reading and playing puzzle games can slow the decline of cognitive function in the elderly, but the effects of specific types of such activities on cognitive function and cognitive domains need to be further studied.

To explore the influence of common types of intellectual activities on cognitive function and cognitive domains of the elderly in the community.

From May to August 2022, stratified convenience sampling was used to select elderly people from four communities in Nanjing, Changzhou, Nantong and Xuzhou of Jiangsu Province. A face-to-face survey was conducted with a general information questionnaire and the Montreal Cognitive Assessment (MoCA) Beijing edition to collect data regarding sociodemographics, frequency and types of intellectual activities, and cognitive function. Stepwise multiple regression analysis was used to explore the relationship between intellectual activities and different cognitive domains.

In total, 782 cases attended the survey, and 758 of them (96.93%) who completed it were included for analysis, including123 from Nanjing, 197 from Changzhou, 240 from Nantong, and 198 from Xuzhou. The intellectual activities done by these older people include learning new knowledge (n=170), playing chess and cards (n=228), reading (n=228), singing (n=59), playing puzzle games (n=57), helping grand children with their homework (n=42), painting (n=16), playing a musical instrument (n=47), and practicing calligraphy (n=30). Stepwise multiple linear regression analysis showed that learning new knowledge, reading, helping grand children with their homework, playing puzzle games and playing musical instruments were associated with cognitive function (P<0.05). Learning new knowledge (B=0.250), reading (B=0.590), playing puzzle games (B=0.585), helping grand children with their homework (B=0.711), and playing musical instruments (B=0.643) were the influencing factors of Visuospatial/Executive (P<0.05). Learning new knowledge (B=0.219) was an influencing factor of Abstraction and Delayed recall/Memory (B=0.727) (P<0.05). Reading was a factor affecting Naming (B=0.095), Attention (B=0.207), Language (B=0.290), Abstraction (B=0.241), and Delayed recall/Memory (B=0.377) (P<0.05). Playing puzzle games (B=0.290) and playing musical instruments (B=0.278) were the influencing factors of Language (P<0.05). Among various types of activities, reading was included in a total of seven regression equations, with a standardized regression coefficient of 0.225 for its impact on the total score of MoCA, which was higher than that of the other types.

Intellectual activities such as reading, learning new knowledge, playing puzzle games, helping grand children with their homework and playing a musical instrument can maintain or improve the cognitive function of the elderly in the community. The effects of different types of intellectual activities on cognitive function are domain-specific, which has a positive significance for the prevention and intervention of cognitive function decline of the elderly.

The prevention and delay of disability is important for promoting healthy aging. Exercise intervention is an efficient strategy for disability prevention. Besides, exercise intervention presents significant therapeutic advantages and broad application prospects due to low cost, low implementation difficulty, high acceptance and wide application scenarios. Therefore, Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences jointly developed and published Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023). According to the methodologies specified in WHO Handbook for Guideline Development, the guidelines finally involve 32 recommendations and 18 clinical issues containing exercise principles, effectiveness and plans of different types of exercise, facilitators and barriers during exercise, aiming to provide a reference for the development and implementation of exercise programs for older adults at risk of disability and standardize clinical practice, thus promoting the gateway to improving physical function of the older adults, reducing the prevalence of disability, improving quality of life, contributing to healthy aging.

Sleep disorders combined with subjective cognitive decline (SCD) in older adults are associated with an increased risk of cognitive decline and dementia conversion. However, sleep problems in older adults with SCD have not received sufficient attention, the sleep subtypes of older adults with SCD and their influencing factors need to be further investigated.

To explore potential sleep subtypes in older adults with SCD and analyze the influencing factors of different sleep subtypes.

From May to August 2022, older adults with SCD were selected as subjects from the communities in Nanjing, Changzhou, Nantong, and Xuzhou in Jiangsu Province using a stratified convenience sampling method. The general information questionnaire, Subjective Cognitive Decline Questionnaire (SCD-Q9), Beijing Version of the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL) were used to conduct the survey. The latent profile analysis of sleep in older adults with SCD was performed based on the dimension scores of the PSQI scale, unordered multinomial Logistic regression analysis was used to examine the influencing factors of sleep subtypes in older adults with SCD.

A total of 287 older adults with SCD were enrolled, and the results of the latent profile analysis showed that sleep in older adults with SCD can be classified into 3 potential subtypes: relatively good sleep subtype (n=200), sleep deprivation subtype (n=63), and difficulty falling asleep-medicated hypnosis subtype (n=24), accounting for 69.7%, 21.9%, and 8.4% of all respondents, respectively. There were significant differences in gender, smart phone use, PHQ-9 scores and FRAIL scores among different sleep subtypes (P<0.05). Using the relatively good sleep type as a reference, the unordered multinomial Logistic regression analysis showed that gender 〔sleep deprivation subtype: female, OR=2.479, 95%CI (1.279, 4.808) 〕, smart phone use 〔sleep deprivation subtype: yes, OR=0.269, 95%CI (0.090, 0.808) 〕, PHQ-9 score 〔sleep deprivation subtype: OR=1.755, 95%CI (1.416, 2.175); difficulty falling asleep-medicated hypnosis subtype: OR=1.992, 95%CI (1.540, 2.576) 〕were influencing factors of sleep subtyping (P<0.05) .

Sleep in older adults with SCD showed significant population heterogeneity, and more attention should be paid to the sleep status of older adults with SCD who are female, use smart phones, and have depressive tendencies. Early and precise interventions for different sleep subtypes need to be performed early to improve sleep quality and prevent or delay the development of cognitive impairment.

At present, there are few intervention studies on cognitive frailty in elderly diabetic patients. This study aims to explore the application effect of Baduanjin combined with cognitive training in elderly diabetic patients with cognitive frailty, in order to provide reference for the management of this population.

To explore the intervention effect of Baduanjin combined with cognitive training on elderly diabetic patients with cognitive frailty.

A total of 84 elderly diabetic patients with cognitive frailty hospitalized in the Department of Endocrinology, Shanxi Provincial People's Hospital from October 2021 to April 2022 were selected as research subjects by convenient sampling method, and randomly divided into the experimental group (n=42) and the control group (n=42) according to the random number table method. The patients in the experimental group received Baduanjin exercise combined with cognitive training, 3 times per week for 12 weeks; patients in the control group were given routine exercise and health education. General data of the patients were collected, including gender, age, education level, marital status, residential status, personal monthly income, type of medical insurance and number of comorbid chronic diseases. The Montreal Cognitive Assessment (MoCA) score, Frailty Phenotype (FP) score, gait speed, grip strength and glycated hemoglobin A1c (HbA_1c) were compared at baseline, 6 weeks and 12 weeks of intervention between the two groups.

During the study period, 3 cases were lost to follow-up in the control group and 2 cases were lost in the experimental group, a total of 79 patients were finally included (39 cases in the control group and 40 cases in the experimental group) . There was no significant difference in the general data between the two groups (P>0.05) . There were interaction effects of group and time on MoCA score, FP score, gait speed and grip strength (P<0.05) . MoCA score of patients in the experimental group was higher than that in the control group at 12 weeks of intervention (P<0.05) , and higher than that at baseline and 6 weeks of intervention (P<0.05) . FP score of patients in the experimental group was lower than that in the control group at 12 weeks of intervention, and lower than that at baseline and 6 weeks of intervention (P<0.05) . Gait speed and grip strength of patients in the experimental group were higher than those in the control group at 12 weeks of intervention, and higher than those at baseline and 6 weeks of intervention (P<0.05) . HbA_1c level of patients in the experimental group was lower than that in the control group, and lower than that at baseline at 12 weeks of intervention (P<0.05) .

Baduanjin combined with cognitive training can slow down the decline of cognitive function in elderly diabetic patients, improve physical frailty and reduce the blood glucose level of patients, which is suitable for vigorously promoting in the clinical and community settings.

In China, as population aging quickens, multimorbidity has become a major public health problem threatening the health of elderly people. Multimorbidity has a negative impact on mental health, but there is a lack of research on its association with anxiety symptoms in elderly people.

To investigate the influence of multimorbidity on anxiety symptoms among Chinese elderly people, so as to provide references for improving mental health for older people with multimorbidity.

We selected 6 854 older adults (≥65 years old) from the participants of the Chinese Longitudinal Healthy Longevity Survey 2018 from December 2022 to February 2023. The 7-item Generalized Anxiety Disorder Scale was used to assess symptoms of anxiety. Multimorbidity was defined as having two or more coexisting chronic conditions, while non-multimorbidity was defined as having only one or no chronic condition. Propensity score matching (PSM) was used tomatch individuals with and without multimorbidity. The association of multimorbidity with anxiety symptoms was analyzed by univariate and multivariate Logistic regression analyses.

Among the 6 854 cases, the prevalence of multimorbidity and anxiety symptoms was 38.04% (2 607/6 854), and 10.53% (722/6 854), respectively. There were 4 247 cases (61.96%) without multimorbidity, of whom 2 102 (30.67%) had no chronic disease, and 2 145 (31.29%) had one chronic disease. A total of 2 282 pairs of multimorbidity and non-multimorbidity (4 564 cases altogether) were obtained after matching. Multivariate Logistic regression analysis showed that multimorbidity was the risk factor of anxiety symptoms〔OR=1.399, 95%CI (1.166, 1.679), P<0.001〕. Besides that, gender, ability to perform activities of daily living and receiving a pension were also related to anxiety symptoms (P<0.05). Five hundred and twenty-two pairs (1 044 cases altogether) were obtained after matching the subjects with multimorbidity and those with one chronic disease using PSM, and the analysis found that those with one chronic disease had higher prevalence of anxiety symptoms〔64.76% (215/332) vs 43.12% (307/712) 〕 (P<0.001) .

Compared with their counterparts without multimorbidity, elderly people with multimorbidity had higher risk of anxiety symptoms, so more attentions should be paid to the mental health of these people.

The recurrence rate of late-life depression is high, however, there is a lack of research on intervention protocol to prevent recurrence of late-life depression at home and abroad.In the early stage, the research group explored the risk factors for recurrence of late-life depression, and the controllable risk factors were poor medication compliance, less physical activity, and less eating.

To search, evaluate and summarize the evidence related to the prevention of recurrence of late-life depression based on the above three risk factors.

In October 2022, the evidences related to the prevention of recurrence of late-life depression were searched in Web of Science, PubMed, Cochrane Library, American Guide Network, British Guidebook, Website of Registered Nurses Association of Ontario (RNAO), Evidence-based Nursing Center of Fudan University, CNKI and other databases from inception to October 2022, which include guidelines, systematic reviews, expert consensuses, evidence summaries, etc. The quality of the included guidelines, systematic reviews, expert consensuses and original researches were evaluated by investigators trained in systematic evidence-based medicine using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ) Instrument, AMSTAR, and the Australian Joanna Briggs Institute (JBI) evidence-based center evaluation standards (2016 version), respectively. Finally, the 2014 Australian JBI evidence-based health care center evidence grading and recommendation level system was used to summary, evaluate and grade the evidence.

A total of 15 articles were included, including 3 guidelines, 11 systematic reviews and 1 RCT. The qualities of the 3 guidelines were graded as B or above, the qualities of 11 systematic reviews were graded as medium or above, and the quality of 1 RCT was graded as B. A total of 24 best evidence items were summarized from 6 aspects of intervention evaluation, diets and nutrition, exercise and rehabilitation training, psychosocial interventions, medication compliance, and effect evaluation.

The study summarizes the best evidence for prevention of late-life depression, suggesting that clinical staff should comprehensively evaluate the patients, and develop individualized intervention program focus on evaluation, diets and nutrition, exercise and rehabilitation training, medication compliance guidance, and psychosocial interventions, combining with the characteristics of patients and diseases.

The cost of end-of-life care is an important topic in health and wellness sector. There are few studies focus on the end-of-life medical expenditures of older adults in China, especially the causes of urban-rural differences in end-of-life medical expenditures in this population.

To investigate the associated factors of medical expenditures of Chinese oldest old population (≥80 years) in the year before their death, and to analyze rural-urban differences in the medical expenditures as well as their causes.

In September 2021, 1 399 oldest-old adults who died in 2014—2018 with full data of medical expenditure and other key variables in the year prior to their death were selected from the participants of Chinese Longitudinal Healthy Longevity Survey 2018. Ordinary least squares regression was used to analyze the associated factors of the medical expenditures. The Oaxaca-Blinder technique was used to decompose urban-rural differences in the expenditures.

The median medical expenses of the participants in the year prior to their death was 3 500.00 yuan, and the interquartile range was 9 000.00 yuan, the logarithmic mean value was (8.09±1.73) yuan. The residence, age at death, gender, marital status, living arrangement, prevalence of disability, prevalence of endowment insurance, place of death, accessibility of medical services, prevalence of being confined to bed, and annual household income per capita were factors associated with the medical expenditures in the year prior to death (P<0.05). After controlling for confounding factors, the medical expenses of the urban participants in the year prior to their death was 42.6% higher than that of participants living in rural areas. According to the findings of Oaxaca-Blinder decomposition, the explainable and unexplainable parts of the urban-rural differences accounted for 32.86% and 67.14%, respectively. Of the explainable part, 18.70% was caused by differences in endowment insurance participation, 30.18% by differences in place of death, and 40.42% by differences in annual household income per capita.

The medical expenditures in the year prior to death in the oldest-old were associated with complex factors, and showed large urban-rural differences. It is essential that efforts should be made to implement healthy aging strategies, balance the allocation of urban and rural medical resources, improve social security system for older adults, and to develop end-of-life care. All of these will help reduce the medical expenditures and improve the quality of life and death of older adults at the end of their life.

With the aggravation of population aging in China, the number of elderly perioperative orthopedic patients is increasing, and the growing prevalence of frailty in older patients undergoing orthopedic surgery has attracted increasing attention. Early preoperative assessment and intervention of frailty are of great significance for improving postoperative prognosis and reducing the occurrence of complications in this population.

To perform a scoping review of frailty assessment tools for elderly orthopedic inpatients, and to provide a reference for the selection of frailty assessment tools for this group.

Seven databases (PubMed, CINAHL, PsycINFO, Scopus, Embase, CNKI and Wanfang Data) were searched for studies on frailty assessment tools for older orthopedic inpatients from 2006 to 2021. Two researchers independently screened the literature and extracted the basic characteristics of the literature (the flint author, publication time, country, basic information, research tools and outcome indicators) and the basic characteristics of involved frailty assessment tools (name, study country, study type, scale dimension, number of items, assessment cut-off value, assessment time, etc.) .

A total of 1733 studies were retrieved, and 25 of them with 12 frailty assessment tools were included. The analysis showed that there are a variety of assessment tools, and different studies have used different frailty assessment tools. Frailty Phenotype and Frailty Index are the two common tools. The application of accurate and effective tools for frailty screening is crucial to improving preoperative risk stratification and postoperative prognosis. Frailty assessment using the Reported Edmonton Frail Scale, FRAIL Scale, PRISMA-7 Questionnaire or the Groningen Frailty Index can be completed without the use of additional measuring equipment and surveyors with an experience of training.

The selection of an optimal frailty assessment tool for elderly orthopedic inpatients should be in accordance with patient features, clinical resources and the performance of the tool. However, there is still lack of a gold standard for frailty assessment. Future studies are needed to assess the reliability and validity of existing frailty assessment scales or to develop frailty assessment tools applicable to Chinese older orthopedic inpatients.